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#SAMHSA #cognitivedisabilities #vocationalrehabilitation

Improving Treatment for People with Physical and Cognitive Disabilities
SAMHSA TIP 29
Dr. Dawn-Elise Snipes
Objectives
~ Define the impact of disabilities on the 7 categories of functional capacity
~ Explore unique challenges for people with disabilities
~ Identify attitudinal, procedural and treatment barriers and methods to mitigate them
~ Review other identified behavioral targets
Intro
~ People with physical and cognitive disabilities have unique issues in treatment
~ People may have the same disability without having the same functional capacities and limitations
7 Categories of Functional Capacity
~ Self-Care
~ Mobility and Transportation
~ Communication (expressive and receptive)
~ Learning (attention, comprehension, retention, application)
~ Problem Solving and Abstraction
~ Social Skills
~ Executive Functioning
~ Persons with mental illness often have impairments in memory and executive function that impede learning and behavior change.
Conditions more prevalent in people with DDs than the general population
Social Isolation
Families' efforts to protect them
Physical difficulty of getting out to social settings
Lack of opportunities to practice social skills
Lack of physical stamina potentially due to obesity
Lack of energy due to meds (opioids, antipsychotics)
Trouble finding getting to recreational activities
Poverty
Nondisabled people's discomfort with people with disabilities
Altered body image in those with a recent disability (wheelchair, insulin pump, ostomy bag)
Low self esteem
Conditions more prevalent in people with DDs than the general population
Unemployment/poverty (30% live below poverty line)
People with disabilities at all income levels generally spend a large proportion of their income to meet their disability-related needs
Lack of employment skills
Homelessness
Victimization
Caregiver exploitation (financial abuse)
Abuse
Identifying hidden disabilities is the key to successful treatment.
A patient who repeatedly fails at treatment may not understand what he is told, or may not be able to read or remember materials.
Many people who have disabilities (e.g., multiple sclerosis, seizure disorders, cardiac problems, autoimmune disorders) look healthy much of the time, but these conditions often cause significant fatigue or limitations on walking, driving, or other physical activities.
Summary
~ Clinicians may inadvertently overlook some confounding issues for people with cognitive or physical disabilities, focusing only on the “presenting issue”
~ Assisting people in achieving their highest quality of life means ensuring they are able to be safe and meet their biopsychosocial needs by screening for obstacles and providing resources and linkages.
~ For more resources and information see TIP 29 Treatment for People with Physical and Cognitive Disabilities

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